Organization
PTL PEDIATRIC DAYCARE CENTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ALLEN CLARK (ADMINISTRATOR)
(530) 891-0657
Entity
Organization
Contact information
Practice address
1890 BEDFORD DR, CHICO, CA 95928-7352
(530) 343-8344
(530) 343-6683
Mailing address
PO BOX 3726, CHICO, CA 95927-3726
(530) 891-0657
(530) 891-8853
Taxonomy
Speciality
Code
Description
License number
State
385HR2065X
Child Physical Disabilities Respite Care
Primary
550000327
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550000327
CA MEDI-CAL
CA
Enumeration date
02/09/2011
Last updated
02/09/2011
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